MEDICARE: EUGENE FRIEDBERG MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	23146	NJ
2	102L00000X	Psychoanalyst	82800	NY
3	2084P0800X	Psychiatry Physician	82800	NY
4	2084P0800X	Psychiatry Physician	23146	NJ

General Provider Information

NPI Number	:	1871706630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE FRIEDBERG MD LLC

Provider Business Mailing Address
First Line	:	151 E PALISADE AVE
Second Line	:	APT A9
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2248
Country	:	US
Telephone Number	:	201-871-4778
Fax Number	:	201-767-6926

Provider Business Practice Location Address
First Line	:	151 E PALISADE AVE
Second Line	:	APT A9
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2248
Country	:	US
Telephone Number	:	201-871-4778
Fax Number	:	201-767-6926

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EUGENE ALEXANDER FRIEDBERG
Credential	:	MD
Telephone Number	:	201-871-4778

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/28/2007

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